Arginine Enriched Nutrition in Trauma Patients

Abstract

Nutritional status is affected by traumatic injury that induces a stress response which is necessary for recovery of the patient. When the trauma patient develops complications, the patient may become “critically ill”; a condition that requires large quantities of nutrients. Different combinations of nutrients (e. g., arginine, glutamine, fish oils, and nucleotides) have been given to different groups of patients in order to enhance the immune system and to improve organ function. Immunonutrition containing arginine has proven to be successful in elective surgical patients. Interestingly, recent studies showed that immune-enhancing formulas with arginine adversely affected outcome in septic patients. Although the exact mechanism of this harm has not been elucidated, the function of arginine as precursor of nitric oxide (NO) might be of interest. Overproduction of NO may be disadvantageous by exerting cytotoxic effects and causing haemodynamic disturbances. Arginine enriched nutrition should not be routinely given to all critically ill patients until potential harmful effects of additional arginine in subgroups of ICU patients are elucidated. Noteworthy, trauma patients on the ICU might benefit from arginine supplementation during the first weeks of their illness because, in this period, they can be regarded as postoperative surgical patients. However, when their inflammatory response is exaggerated such as during sepsis or when arginine plasma levels are already increased such as in critically ill patients suffering from hepatic failure, nutritional support including arginine may not be indicated.

Key words

Trauma patients - critical illness - nutrition - arginine

References

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